Asthma ManagementPathophysiology and Management
University of UtahCenter for Emergency Programs
and
The Utah Asthma Program
Asthma Pathophysiology
Asthma Description
Asthma is defined as a chronic inflammatory disorder of the airways. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or early in the morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.
Asthma Triggers
• Indoor Air Pollutants• Outdoor Air Pollutants• Other Types of Triggers
Indoor Air Pollutants
• Second Hand Smoke• Combustion Products• Biologicals• Volatile Organic
Compounds
Outdoor Air Pollutants
• Ozone (O3)• Particulate Matter
– Nitrogen Dioxide (NO2)– Sulfur Dioxide (SO2)
Other Types of Triggers
• Vigorous Exercise• Exposure to Cold
– Sudden Changes in Temperature• Excitement• OTC Medications
– Non-SteroidalAnti-Inflammatories
Specific Pathophysiology
• With exposure to a trigger, a cascade of cellular responses result in:– Increased mucus production– Mucosal swelling– Bronchial muscle contraction
Pathophysiology Continued
• Early Acute Result is:– Hyperesponsiveness– Obstruction
• Late Acute Result is:– Recurrence of symptoms in 4-12 hours
• Chronic Result is:– Airway Remodeling
Asthma Signs and Symptoms
Classification of Asthma
• Mild Intermittent Asthma• Mild Persistent Asthma• Moderate Persistent Asthma• Severe Persistent Asthma
Asthma as a Diagnosis
Special Populations
• Infants• Children• Teenagers• Pregnant Women
Asthma Management
Asthma Management Plan
• Medications• Management Goals• Physician Information• Individual Triggers
Asthma Action Plan
• Peak Flow Measurements• Asthma Symptoms• Asthma Medications• Emergency Numbers
Asthma Medications• Bronchodilators (Sympathomimetics) • Bronchodilators (Anticholinergics) • Inhaled Corticosteroids• Biologic Response Modifiers
(Monoclonal Antibodies)• Leukotriene Receptor Antagonists• Mast Cell Stabilizers• Methylxanthene Derivatives
Bronchodilators (Sympathomimetics)
• Albuterol• Salmeterol• Terbutaline
Bronchodilators(Anticholinergics)
• Ipratropium
Inhaled Corticosteroids
• Beclamethasone• Flunisolide• Triamcinalone
Biologic Response Modifiers (Monoclonal Antibodies)
• Omalizumab
Leukotriene Receptor Antagonists
• Montelukast• Zafirlukast
Mast Cell Stabilizers
• Cromolyn• Nedocromil
Methylxanthene Derivatives
• Theophylline
Additional & Alternative Therapies
• Asthma Education
• Cognitive Behavioral Therapy– Relaxation Exercises
• Chinese Herbal Therapyhttp://nccam.nih.gov/
Implications for EMS Providers
• Recognize Asthma Triggers• Recognize Asthma Symptoms• Understand …